Comments on: Hard Facts for Potential Coronary Bypass Victims

By: amwrit

amwrit — Sun, 12 Jun 2011 23:54:30 +0000

I notice your last entry on this blog was in 2009. Are you still well? I have been told the same by my cardiologist. A ticking time bomb. I am a female who has grown her own bypass. Curious to see how you are now?
Also, is the prognosis for females different?
Thank you

By: Captks

Captks — Sat, 11 Jul 2009 22:59:42 +0000

Excellent and very helpful. I decided to go for chelation theraphy instead of Bypass recommended by the cardilogist.

By: AK

AK — Mon, 11 May 2009 22:58:57 +0000

So there have been a number of studies looking at patients like you (i.e. stable angina) and evaluating a medical vs. surgical option. If you’re interested a nice meta-analysis that includes ~2600 patients (comprising 7 randomized controlled trials) found that a strategy of initial CABG resulted in lower mortality at 5 (10 vs. 15%), 7 (15 vs. 21%)and 10 (26 vs. 30%) years. To be clear - that means 10% mortality at 5 years in the inital CABG arm, and 15% mortality in the medical arm. So note that 85% of folks were still alive in the medical arm at 5 years. However, an extra 5% were alive with an initial CABG approach. Now, an examination of subgroups demonstrated that higher risk folks benefited the most, while lower risk folks didn’t benefit at all, and had a trend towards worse outcomes with bypass! (Higher risk folks would primarily include, but not be limited to those with left main stenosis, or low ejection fractions). This data in large part drives the current recommendations for CABG (3 vessel disease or left main disease)…with the understanding that high risk folks - low ejection fractions being a big one - benefit the most.
So it is absolutely reasonable to take an initial medical approach to someone with stable angina who has low risk features. Even if you’re medium or high risk…you could take a medical approach, as long as you understand the numbers - meaning if a 100 patients with triple vs. disease and high risk features took an initial medical approach, 15 of them would be dead in 5 years. If you took the surgical approach 10 would be dead. I don’t know your coronary anatomy, and how proximal the lesions are, but hopefully you’re among the 85% that does well. I do disagree with the non-cholesterol lowering…I think one ignores a wealth of data that suggests benefit from statins like lipitor in folks who have coronary disease.

By: Cyn

Cyn — Tue, 27 Jan 2009 05:55:24 +0000

1 year ago this month I had a heart attack. 3 ECG’s said everything was fine…blood oxygen levels were 99%…blood pressure tends to be low rather than high 115/55…after almost 12 hours wait to be seen by a doctor, blood tests were done…the only indicator of a heart attack…other than severe chest and arm pain…was the enzyme in my blood.The angiogram revealed that I had a single 100% blockage but my body had done its own bypass…other than that blockage my veins are exceptionally clean..only 2 other areas with less than 30% blockage…I cannot get or find very much information…I cannot get any real answers or explanations…my cardiologist has seen me twice in that year and says I’m fine…I don’t feel fine yet…I still get very tired…I saw the new artery…it is quite small in comparison…will this change? Are there medications to encourage growth? Should I be doing anything differently from other heart attack patients? Where can I get more information?

By: VASSA

VASSA — Tue, 16 Dec 2008 06:24:06 +0000

Help I am a former Dr Wayne success story who is again suffering from severe angina. My Cardiologist insists that an angioplasty is my only option. What do I do?

By: Miken Hickman

Miken Hickman — Fri, 14 Dec 2007 13:59:02 +0000

Dear Dr. Reyes,
I am in highschool,and our senior project is to talk about what we want to do when we grow up… One of the requirements of my report is that I have t o interview someone in the following profession.My dream career is to be a Cardiologist. I know you are a very busy person but I was wondering if at all possible I could interview you through online.If you are not able to do this I completely understand……
Sincerely,
Miken Hickman

By: wordworks2001

wordworks2001 — Mon, 11 Dec 2006 12:07:54 +0000

Thanks for the comment Maria. I sometimes get wrapped up in this issue so much that I need to step back and be more tolerant and understanding. Most ignorance is not the fault of the ignorant, but of those who taught them. I had a really hard time convincing my pharmacist that indeed, my cardiologist did want me to take the doses of the medications he put me on and to dispense them exactly as written. I even paid for the extra tablets for a while until my pharmacy finally gave in and began charging it to my insurance.

By: maria_i

maria_i — Thu, 07 Dec 2006 15:40:59 +0000

Jeff,

I think Dr. Reyes probably is well-meant, but maybe she hasn´t had enough information.

My father is a Cardiologist, he is 81 y.o. and is retired. He keeps reading and learning about new techniques in Cardiology, and he is still a teacher. As Dr. Reyes, he was a Cardiologist before CABG was a common practice. When we told him about Dr. Wayne’s points of view he was very reluctant. For decades doctors had been told that bypass surgery was safe and the better option. Then he read and re-read most of the studies posted in Dr. Wayne’s site from their original sources. Finally, he was truly convinced that CABG (and agioplasty/angiograms)is absolutely over-prescribed, and that Dr. Wayne’s philosophy was right.
Today, he is still reluctant to Dr. Wayne’s medication dosages and a few other points, but at least there is one doctor telling new Cardiologists that CABG is not necessarily the best.

Maybe Dr. Reyes would want to check deeper on mortality statistics and studies.

Thanks for posting this article.

By: wordworks2001

wordworks2001 — Wed, 06 Dec 2006 08:51:15 +0000

Oh, and Dr. Reyes,

Regarding the VA study you cited. How do you like this one?

Twenty-two Year Follow-up in the VA Cooperative Study of Coronary artery bypass surgery for Stable Angina. Peduzzi, P, Kamina A, Detrie, K, American Journal of Cardiology. 1998; 81; 1393-1399.

Between 1972 and 1974 354 patients with symptomatic coronary artery disease were assigned to conservative medical treatment and 332 with similar symptomatic coronary artery disease were assigned to surgical revascularization. [b]The overall 22 year cumulative survival rate for the medically treated group was 25% while it was 20% in the surgically treated group. The probability of being free of heart attack was significantly higher in the medically treated group (57% vs. 41%). The authors conclude that the trial “provides strong evidence” that initial bypass surgery does not improve survival or reduce the overall risk of a future heart attack. On the contrary, invasively treated patients were much more likely to suffer a heart attack or die compared to patients who are not treated surgically.[/b]

By: wordworks2001

wordworks2001 — Wed, 06 Dec 2006 08:38:22 +0000

Dr. Reyes, I don’t know if you are a cardiologist, but as a physician, you should know that the American Heart Association and the American College of Cardiologists, in their own standards, state CABGs should not be performed as the treatment of choice for CAD, except on the occassion of three specific locations of blockages, that are fairly rare, or when certain compromises of heart function have occurred. Yet for many America cardiologists, it is the treatment of choice.

My heart was healthy, according to the interventionalist. It was receiving oxygen. It was not eschemeic. Why then did he think a CABG would cure my angina? Didn’t he know about angiogenesis and collateral vessels? Why couldn’t he answer my questions about that then?

Don’t answer. Obviously he was more interested in the fee for the CABG he was going to assist on two days later than treating me appropriately with medication.

What did my noninvasive cardiologist do? He didn’t put me on a special diet. He took me off the Lipitor the interventionalist started and told me to never take it again. In fact, he told me to forget about cholesterol all together. He said he hadn’t had his cholesterol levels checked since he was in medical school and he attended long before you did.

One question doctor, If I was a walking time bomb in the spring of 2004 and I am still walking around the end of 2006, am I a dud of a walking time bomb or is my interventionalist cardiologist a dud?

By: Nancy Reyes

Nancy Reyes — Wed, 06 Dec 2006 03:10:10 +0000

SHHH…we docs know about angiogenesis. And if we could be sure that it would happen in our patients, we could spare the bypass surgery.

You see, I’ve been in medicine before they did bypasses, and you know what? Some people with stable angina lived for years, although many were misearable. Some got better. The only “treatment” was diet and exercize and nitroglycerin back then.

Similarly, we knew that a vegetarian low cal diet combined with a gradual increased exercize program would result in improvement almost as much as surgery. We’ve known that since 1970 (maybe before, but I graduated 1971).

Alas, it doesn’t work in the real world. You try telling grandma she needs to stop eating cannoli.

When they did a comparison study of diet/exercize/medicine vs bypass in the VA, they found the first group ended up having more heart attacks or having so many symptoms the guys insisted on the bypass.

You see, in the real world our patients don’t eat correctly, don’t exercize, and want a quick fix.

Now we have a third choice, stents, but they work better for one or two blockages, not someone with arteries that are full of junk.(i.e. diffuse arteriosclerotic placques).

Now, if these new stem cell injections work, maybe we can stop doing bypasses. Then I’ll agree with you.
In the meanwhile, continue what you’re doing. I love it when patients actually take care of their own health.